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How Gay Porn Undermines Safe Sex Campaigns VIEWS & REVIEWS

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How Gay Porn Undermines Safe Sex Campaigns VIEWS & REVIEWS An insider’s view of the drug industry, VIEWS & REVIEWS p 776 How gay porn undermines safe sex campaigns PERSONAL VIEW Richard Hurley n the early days of the HIV pandemic porn DVDs on sale through sex shops from London’s Charing Cross Hospital in the 1980s, chilling advertisements and the gay press are condom free—and (which runs a service for people working included a tombstone-like monolith are marketed as such. Their titles often in the sex entertainment industry) and emblazoned with the AIDS acronym, contain the words “bareback” or “raw,” the support of Gay Men Fighting AIDS. while John Hurt cautioned, “If you and their covers sport icons of crossed-out The code aims to protect performers by Iignore AIDS it could be the death of condoms. With increasing deregulation recommending that condoms be used for you, so don’t die of ignorance” ( www. and competition from the internet, porn anal sex. It also emphasises the need for nationalarchives.gov.uk/fi lms/1979to2006/ studios are exploiting taboos to maintain studios to insist on seeing certificates to fi lmpage_aids.htm ). market share. show that performers have recently been Such terrifying safe sex messages Bareback sex puts porn performers tested for sexually transmitted infections. seem to have all but dried up, however. at risk. Last year the BBC’s Newsnight The US director Chi Chi LaRue has taken At the same time the depiction, indeed programme reported that HIV infection a public stance against bareback porn and celebration, of unprotected anal was diagnosed in four men soon after produced a public service film to promote intercourse in gay pornography has risen they took part in a shoot ( http:// safer sex ( www.safesexishotsex.com ). massively. The message this sends to news.bbc.co.uk/1/hi/programmes/ The condom is a physical barrier young gay men that sex without condoms newsnight/7277000.stm ). Some studios between partners in what should be a is OK is putting them at risk of HIV and reacted to this exposé by setting up highly intimate interaction and is often other sexually transmitted infections. the Gaikiss (gay adult industry criticised for spoiling the moment. The essence of today’s sexual health keeping its sex safer) campaign In the post-AIDS mentality, many messages is that, because of advances in ( www.gaikiss.org.uk ). This gay men see bareback sex as more testing and treatment, people with HIV collaboration has developed a authentic, more pleasurable, and live normal and healthy lives. Of course, code of practice, with advice CONDOM FREE more masculine. If bareback porn the reality isn’t so simple, and AIDS has does not fetishise risky sex, it at no cure. The government and gay health least eroticises it. groups no longer rely on an authoritarian The use of condoms in porn films voice to encourage condom use. Instead, normalises safer sex and offers practical campaigns reflect a drive to reduce the demonstration. Many films show sex stigma associated with being HIV between men under the age of 30. And positive. because most young men learn about sex This has led some gay men to reach through pornography, it seems likely that warped conclusions—for example, that they may mimic their screen heroes in it is inevitable that they will contract their own sexual practice. the virus and that when they do it won’t Doctors should: matter too much because of what they see • Remind their young gay male patients to as the panacea of antiretrovirals. Add to use condoms, especially with new partners this the misconception that post-exposure • Suggest to gay men that they ask about a prophylaxis provides a “morning after pill” new partner’s HIV status and that they are for HIV, and unprotected sex seems even honest about their own less of a big deal. • Recommend that gay men be tested But AIDS is a big deal. Since 2003 regularly for sexually transmitted infections the annual number of reported HIV and that this should always include HIV, diagnoses in gay men has consistently and increased, to exceed the statistics for • Demand universal antigen or genomic the 1980s and 1990s. The incidence testing rather than antibody testing, which in the United Kingdom in 2006 can detect HIV within weeks or days rather was almost 3000 ( www.hpa.org.uk/ A growing proportion of gay porn than months after infection. web/HPAweb&HPAwebStandard/ DVDs on sale through sex shops and Richard Hurley is a technical editor, BMJ HPAweb_C/1197637002300 ). the gay press are condom free—and [email protected] A large and growing proportion of gay are marketed as such Cite this as: BMJ 2009;338:b910 BMJ | 28 MARCH 2009 | VOLUME 338 775 VIEWS & REVIEWS REVIEW OF THE WEEK An insider’s view of the drug industry A view of the drug industry from inside the laboratories is one long apologia, finds Allen F Shaughnessy Drug Truths, written by a research chemist who spent his given alone. Several years into this testing the company career with Pfizer, presents a view of the industry from announced, with great fanfare, the profound effects on inside the laboratory. Although he exchanged his white lipid concentrations being reported in the clinical trial. coat for a pinstripe suit as he moved during his career Just two days later the lead scientist received a phone call from the bench to become Pfizer’s president of global from the chairperson of an independent data monitoring research and development, John LaMattina has not committee; an interim analysis showed higher mortality lost his sense of wonder at the drug discovery business in the patients treated with the new drug. and breathlessly presents this side of the industry as he The work of hundreds of scientists over 17 years came attempts to bust the so called myths that surround it. to a sad end. The trial was halted, the drug shelved. In The human side of pharmaceutical research is illus- unscientific terms a scientist expressed his feelings: “I trated in the author’s recounting of the 17 year devel- know I entered an alternate reality that day . It must be opment and subsequent heartbreak of torcetrapib, a something that anyone in bereavement might feel. Some- cholesterol lowering drug. The story begins in 1990 after thing was gone that would never be replaced, a hole in Drug Truths: Dispelling a report was published on a gene mutation occurring in my heart that will remain for ever . My wife said it best. the Myths about four families in Japan. The families lacked cholesteryl I was acting as though I had lost a 6-year-old child.” Pharma R&D ester transfer protein, resulting in very high concentra- In other chapters LaMattina takes on other criticisms of John L LaMattina tions of HDL cholesterol, low amounts of LDL choles- the industry. He picks the unfortunate example of cyclo- WileyBlackwell, £16.95, terol, and no evidence of premature atherosclerosis. oxygenase-2 inhibitors as proof that new drugs are safer pp 152 Chemists at Pfizer, including the author, set about than traditional medicines. He defends the industry’s ISBN 978-0470393185 finding a chemical inhibitor of this enzyme. By screen- development of “me too” drugs, making the case (cor- Rating: ing thousands of molecules for their ability to inhibit the rectly) that doctors need more than one or two options **** enzyme, and developing new chemical entities for testing, to treat patients and arguing (incorrectly) that each new they identified a substance with weak inhibitory activity. drug on the market adds a clinically relevant benefit. Is Further years of experimentation yielded a modification the 24th non-steroidal anti-inflammatory drug that much that boosted the pharmacological effect to clinically rel- better than the first few? Do we really need three drugs for evant levels. erectile dysfunction or 12 individual or combination stim- Now it was the turn of the pharmaceutical scientists, ulants to treat attention deficit hyperactivity disorder? who were tasked with developing a product that would He dismisses the notion of disease mongering, arguing be absorbed when taken as a pill. By the time they were that preventive medicine dictates that risk factors such as finished, eight years of development and testing had osteoporosis, hypercholesterolaemia, and hypertension occurred before the first human ever took the drug. are true diseases, as are fibromyalgia and post-traumatic In phase I clinical testing, healthy volunteers showed stress disorder. He sidesteps the issue of balding as a dis- impressive results: HDL cholesterol concentration ease, the alteration of disease definitions such as those of increased and that of LDL cholesterol decreased after post-herpetic neuralgia, erectile dysfunction, and bipolar a single dose. At higher doses, HDL rose by 80% and disorder to be more inclusive, and the medicalisation of LDL fell by 40% after only two weeks of treatment. The premenstrual symptoms and social awkwardness. scientists were ecstatic, because the only problem they The excitement, pride, and naiveté of the author of found at this point was a slight increase in blood pressure, Drug Truths are palpable and unabashed: “For many sci- which was eliminated by lowering the dose. entists a job in the Research and Development labs of Phase II testing, involving giving the drug to patients a pharmaceutical company is a dream come true.” Do with hypercholesterolaemia, produced more surprises: not read the book as a careful, unbiased analysis of the in patients with even slightly elevated triglyceride industry; the factual and logical holes in its “myth bust- The author dismisses concentrations, the LDL concentration was not uniformly ing” are large enough to drive a truck through.
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